探讨间隙平衡截骨法结合测量截骨法在全膝关节置换(TKA)术中应用价值和疗效评价。

笔者自2012年1月至2015年6月在濮阳市中医院接受人工全膝关节置换术78例(82膝)骨关节炎的患者，纳入标准：初次全膝关节置换术；膝屈曲挛缩畸形角度≤ 15°；膝内翻畸形角度≤ 20°；Kellgren-Lawrence分期Ⅲ、Ⅳ级。排除标准：膝炎性关节疾病施行人工全膝关节置换术的患者；患者伴发严重的内科疾病；资料不完整、未使用同一厂家生产的后稳定型固定平台假体的患者。其中平衡组38例(40膝)，测量组40例(42膝)。比较分析2组患者的手术情况、影像学、膝关节功能恢复情况及患者满意度。采用成组设计资料t检验进行统计学分析。

78例患者均获随访，随访时间平均(7.6±2.4)个月。2组患者的年龄、性别、体重指数、术前下肢机械力线及KSS评分等指标的差异无统计学意义(P>0.05)。测量组与平衡组单膝手术时间比较差异无统计学意义(P>0.05)，术中2组胫骨外侧及股骨远端外侧截骨量差异无统计学意义(P>0.05)，2组股骨外后髁截骨量比较有显著性差异(t＝4.36, P<0.05)。平衡组选择9 mm垫片者(29例)显著多于测量组(13例)(Z＝－5.28，P<0.05)。术中两钉孔连线B线与AP垂直线A线的夹角<2°，测量组外旋角度(1.1±0.5)°，平衡组内旋角度(1.2±0.5)°，术后患膝伸直应力位X线片示内外侧股胫关节角2组间差异无统计学意义(P>0.05)。但屈膝90°应力下X线片示内外侧股胫关节角2组间差异有统计学意义(内t＝6.76，外t＝7.18, P<0.05)。术后下肢力线与小腿解剖轴线夹角两组间比较差异无统计学意义(P>0.05)。术后3个月膝关节KSS评分2组间差异有统计学意义(t＝4.86, P<0.05)，术后患者满意度调查表示平衡组优良率87.5%(35/40例)，测量组优良率71.4%(30/42例)。

间隙平衡截骨法结合测量截骨法能取得良好的下肢力线和屈伸间隙平衡，还能避免屈曲失稳的并发症。术中易导致股骨假体内旋，要注意调整两钉孔连线B线与AP垂直线A线的夹角。

To investigate the therapeutic effect of patient-gap balancing combine with measured resection in total knee arthroplasty (TKA) and assess the value of patient -gap balancing.

Seventy-eight cases (82 knees) underwent TKA in Pu Yang Traditional Chinese Medicine hospital for osteoarthritis from January 2012 to June 2015 were retrospectively analyzed. Inclusion criteria: primary total knee arthroplasty; flexion contracture deformity angle≤ 15°; varus deformity angle≤ 20°; Kellgren-Lawrence stage of knee osteoarthritis is Ⅲ、Ⅳ.Exclusion criteria: total knee arthroplasty in patients with knee inflammatory disease; serious medical diseases; data incomplete and without posterior stabilized fixed platform prosthesis from the same manufacturer. Thirty-eight cases (40 knees) used gap balancing technique. Another 40 patients (42 knees)underwent measured resection technology . The data of surgery, imaging , knee function and patient satisfaction rate were compaerd.Using t test of group design data for statistical analysis.

All the patients were followed up for 6 to 12months, average(7.6± 2.4)months. The preoperative parameters such as age, gender, body mass index, limb alignment and Knee society score(KSS) were not statistical different(P>0.05) .The one side knee surgery time of the two groups showed no significant difference (P>0.05). There was no significant difference in the bone resection thickness of the distal femoral lateral condyle and lateral tibial plateau between two groups(P>0.05), while the bone resection thickness of the femoral posterior lateral condyle in gap balancing group was significant smaller than that in measured resection group(t=4.36, P<0.05) .The 9 mm polyethylene insert was used in 29 cases of the gap balancing group and in 13 cases of the measured resection group, which showed significant difference(Z=-5.28, P<0.05). Intraoperative two pinholes B line connect with AP vertical A line angle<2°, measured resection groups external rotation angle (1.1±0.5)°, gap balancing groups internal rotation angle (1.2±0.5)°.Postoperative knee straight stress X-ray shown medial- lateral tibiofemoral joint angle of the two groups showed no significant difference (P>0.05), but bent-knee 90°stress was greater in the measured resection groups(Medial t=6.76, Lateral t=7.18, P<0.05). After operation limb alignment and crus anatomic axis angle, There was no significant difference between the two groups(P>0.05). Knee society score(KSS) at three months after operation of the two groups showed significant difference(t=4.86, P<0.05). The patient satisfaction rate was 87.5%(35/40 cases)in gap balancing group, 71.4%(30/42 cases)in measured resection group.

Gap balancing technique in limb alignment and flexion and straight gap balance is better than measured resection technique, but it can cause femoral prosthesis internal rotation intraopertively, attention should be paid to adjust two pinholes of attachment B line with A line angle.